Occasionally, a patient will have good hemoglobin A1c (HbA1c) control (<7.0%) but frequent short-term blood- sugar control problems, likely due to diet and activity variability. Is this considered good control, or do the rather large short-term fluctuations represent poor control as it would affect the patient’s risk of future microvascular disease?
—Scott B. Brasseur, MD, Hastings, Mich.

Treatment goals for patients with type 2 diabetes include lowering HbA1c to <7% as well as keeping fasting glucose at 90-130 mg/dL and postprandial glucose <180 mg/dL. Patients whose blood sugars fall outside these parameters need improved control. The HbA1c represents an average blood glucose; therefore, a normal HbA1c in patients with frequent high sugars may indicate frequent hypoglycemic episodes. Postprandial excursions of blood glucose are implicated in endothelial damage, calling into question the emphasis on using fasting glucose as the primary measure for glycemic control.
—Seonaid Hay, MD, assistant professor of medicine, Yale University School of Medicine, New Haven, Conn. (117-16)

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